Aging: Higher Co-Payments Tied to Costlier Care

When Medicare plans raise co-payments for outpatient care, older people cut back on doctors’ visits, then wind up needing more expensive hospital care, a new study reports.

The study examined changes in the use of inpatient and outpatient care among people in Medicare plans that almost doubled co-payments, and compared the trends with similar plans that kept co-payments steady.

Though outpatient visits increased over time in all plans, health plans that raised their co-pays had slower increases: 19.8 fewer outpatient visits per 100 enrollees compared with plans that kept prices steady.

But they also had 2.2 additional hospital admissions per year, 13.4 more annual inpatient days and a 0.7 percent increase in the number of enrollees who had been hospitalized, when compared with plans that did not raise prices.

The study, published in the Jan. 28 issue of The New England Journal of Medicine, encompassed 899,060 Medicare beneficiaries who participated in 36 plans from 2001 to 2006.

“This is an ill-advised cost containment strategy,” said the paper’s lead author, Dr. Amal N. Trivedi, an assistant professor of community health at Brown University. “The increase in outpatient co-pays appears to produce both greater health care spending and worse health.”

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